Shaun Hanns is a former public servant who worked until recently in the refugee assessment program at home affairs. Last October he left his job to raise concerns about current government policy. He wrote a 10-page paper, which he sent to federal parliamentarians, urging them to interrogate the claims sitting behind Australia’s border protection regime, rather than be party to a set and forget exercise.

More recently, he’s written a submission to a Senate inquiry into the medevac repeal. If you’ve missed the whole medevac debate, it’s easy enough to summarise. Last year, when Scott Morrison governed in minority, crossbenchers, Labor and the Greens succeeded in overhauling the transfer processes for dangerously ill people on Nauru and Manus Island. Clinicians were given more of a say.

Now that Morrison governs in majority, the prime minister wants to repeal the bill that passed the parliament against the government’s wishes. The government also wants to use the process of repealing medevac as an opportunity to extend its powers to return people offshore once their medical issues have been resolved. The proposal to enhance the return powers has flown largely under the radar in the debate to date.

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Hanns has told the Senate inquiry that parliamentarians should keep the crossbench-initiated medevac procedures as “the first step in an attempt to reform the system so that it is not only effective, but as humane as possible, whilst maintaining that effectiveness”.

One bit of compelling logic stood out to me when I read his written submission before it was made public by the committee this week. Hanns said the lived experience of the medevac regime gives policymakers in Canberra important information they should not ignore.

Medevac working effectively demonstrated that Australia’s overall deterrence regime “need not rely on a logic of cruelty in order to be effective”. The experience of the past six months showed “there is significantly more leeway to change the system without undermining border protection than previously assumed”.

You might need a minute or two to process these insights, not because they are particularly complex, but because we don’t always take the time to analyse what’s happening. We don’t reflect on the fact our government, and governments before the current one, use (and have used) cruelty deliberately, institutionally, as a matter of policy, to assert our sovereignty, and dissuade asylum seekers from coming to Australia by boat.

We don’t tend to think about this for two reasons. The first is it all happens out of our sight. The second is a self-protective mechanism: if we remember that institutional cruelty is deployed on our behalf, it triggers moral discomfort.

So I’d recommend you give yourself a minute to mentally step through Hanns’s analysis: the medevac procedures have not led to the sky falling in, so perhaps we don’t need to be quite as terrible to our fellow human beings as we thought we needed to be in order to stop the boats.

It feels like a truth bomb when you take the time to process it.

Truth bomb or not, the Department of Home Affairs isn’t showing much inclination to listen to the suggestion from one of its former operatives. As could have been predicted, the department remains resolutely of the view that when it comes to determining policy, it is their way, or the highway.

Home affairs argues in its submission the medevac regime undermines regional processing, undermines security and impinges on the sovereignty of Papua New Guinea and Nauru.

Strangely, given there is a wealth of evidence that the mental health crisis on Nauru and Manus Island has actually been years in the making, (and this could have been predicted, given, to quote the Royal Australian and New Zealand College of Psychiatrists, “prolonged or indefinite detention itself is known to contribute to adverse mental health outcomes as a result of prolonged exposure to factors including uncertainty, lack of autonomy, deprivation of liberty, dehumanisation, isolation and lack of social support”) – the department suggests in its submission that medevac has somehow been a tipping point.

Truth bomb or not, the Department of Home Affairs isn’t showing much inclination to listen to the suggestion from one of its former operatives.

There is a claim (presented as a “concern”) that people are self-harming in order to get a medical transfer.

The submission notes that during late 2018 and through 2019 “there has been an upwards trend in the number of self-harm related incidents amongst the Papua New Guinea cohort”.

“Notably, self-harm incidents increased during the parliamentary debate on [medevac], and more significantly since the Australian federal election,” the submission says. “Of the 72 transitory persons transferred to Australia … 39 had undertaken an act of self-harm and 19 had threatened self-harm since the implementation of [medevac]”.

Then there’s the kicker. “Home affairs is concerned that self-harm is perceived as the most expedient means of accessing medical transfer under the provisions.”

The department says it has always cared about the health of the people on Nauru and Manus, it has spent hundreds of millions delivering services, and is working with service providers to implement enhanced mental health services. It notes that in April 2019 the Pacific international hospital expanded its operation in Port Moresby and opened an enhanced mental health facility specifically for the transitory person caseload.

It is reassuring that home affairs professes to be concerned about the risks of self-harm, but the picture the submission presents is – how can I put this politely? Somewhat selective.

Overlooked in the commentary is the findings of the Queensland coroner Terry Ryan. Ryan found in July 2018 that the death of Iranian asylum seeker Hamid Kehazaei from complications after an infection was preventable. The coroner recommended that doctors treating asylum seekers and refugees on offshore islands should have control of patient transfers to hospital care in Australia. Importantly, the UNHCR has noted of that case: “The report of the Queensland state coroner in relation to the death of Hamid Kehazaei demonstrates that insufficiently transparent and accountable procedures for acting upon serious health concerns can have life-threatening and tragic consequences”.

Also not mentioned: important work by Médecins Sans Frontières released last December documenting that Nauru was in the grips of a mental health crisis. MSF reported a dangerous mental health crisis had been developing on Nauru for at least four years. Just for background, MSF provided free psychological and psychiatric treatment to Nauruan nationals as well as refugees and asylum seekers sent to the island until the Nauruan government informed the organisation in October 2018 that its services were no longer required and must cease within 24 hours.

Also not mentioned: an unusual personal appeal from the president of the Australian Medical Association to Scott Morrison last September to remove families and children from Nauru, preferably to the Australian mainland, to safeguard their physical and mental health.

Guardian Australia revealed Tony Bartone wrote to Morrison because of “a recent groundswell of concern and agitation across the AMA membership and the medical profession about conditions on Nauru, and the escalation in reports of catastrophic mental and physical health conditions being experienced by the asylum seekers, especially children”. The AMA is standing behind the medevac regime, and urging the government to properly fund the work of the independent health advisory panel that provides the advice on medical transfers.

The fate of the medevac regime rests with one parliamentarian, the Tasmanian independent Jacqui Lambie, who has told the government she wants the Senate inquiry to play out before she makes a decision. Nobody really knows which way Lambie will jump, but she’s the make-or-break player.

Hearings associated with the inquiry begin next week. The critical vote is expected in November.